Born in Kingston, Jamaica, Ewing excelled at cricket and soccer. In 1975, a 12-year-old Ewing joined his family in Cambridge, Massachusetts.[6] He learned to play basketball at Cambridge Rindge and Latin School. While in high school, Ewing's team bus was often rocked by opponents when his team traveled to play an away game.[7] In order to prepare for college, Ewing joined the MIT-Wellesley Upward Bound Program. Upward Bound is a federally funded TRIO college-prep program for low income high school students. He went to Georgetown University in Washington, D.C. and became a citizen of the United States while attending Georgetown.[8]

Ewing signed a letter of intent to accept to play for Coach John Thompson at Georgetown University. Ewing made his announcement in a room full of fans who wanted him to play for Boston College or Boston University. When Ewing announced his decision to play at Georgetown, the fans left the room.[citation needed]

As a freshman during the 1981–1982 season, Ewing became one of the first college players to start and star on the varsity team as a freshman. While at Georgetown, he developed a habit of wearing a short sleeved T-shirt underneath his sleeveless jersey. This started a fashion trend among young athletes that lasts to this day.

In the 1982 NCAA final against the University of North Carolina, Ewing was called for goaltending five times in the first half, setting the tone for the Hoyas and making his presence felt. The Hoyas led late in the game but a shot by Michael Jordan gave North Carolina the lead. Georgetown still had a chance at winning the game in the final seconds, but Freddy Brown threw an infamous bad pass to opposing player James Worthy as he dribbled the ball up court.

In the 1983–84 season, Ewing and Georgetown took the NCAA title with an 84–75 win over the University of Houston. In Ewing's senior year of 1985, Georgetown was ranked number one in the nation and was heavily favored to beat unranked Villanova in the title game, but the Wildcats shot a record 78.6 percent from the floor (22 for 28) to upset the Hoyas 66–64. Ewing was one of the best college basketball players of his era, as Georgetown reached the championship game of the NCAA tournament three out of four years. He was a first-team All-American.

While at Georgetown, however, Ewing was frequently forced to endure racist chants from white college students.[7] At times, spectators even threw objects at him while he was playing. In one game, after Ewing was nearly struck by an orange, coach Jim Boeheim of Syracuse borrowed a microphone and threatened to forfeit the game if fans continued to throw objects at Ewing.[10]

Ewing was expected to be the top pick in the 1985 NBA draft. The team that selected him would be making history by doing so. From 1966 until 1984, the NBA draft was conducted similarly to the NFL draft, where teams are awarded draft positions based on winning percentage. The difference was that instead of the team with the lowest percentage automatically being awarded the top pick, the NBA held a coin toss between the teams with the worst records in each conference and the winner of the coin toss selected first with the loser automatically picking second. This practice tended to encourage teams to purposely lose games in order to improve their draft position and potentially get into the coin toss. The only way two teams from the same conference could have the first two picks would have been if one of the two aforementioned teams traded their pick to another team (like the Indiana Pacers had done with a pick that eventually became the number two pick in the previous year's draft).

Beginning with the 1985 draft, the NBA handled matters differently. Every team that qualified for the playoffs received positions based on their winning percentage, and the teams that did not were placed in a lottery. In the first lottery, the NBA did not determine the positions as they do now. In this case, the seven teams that did not qualify for the playoffs were each given an equal chance to get the top pick. Each team had their name and logo put in an envelope, and the envelopes were placed into a hopper and spun to shuffle them. Once done, Commissioner David Stern then drew an envelope from inside to determine who would pick first. In a move that would create controversy for years to come, the envelope Stern drew was the one belonging to the New York Knicks. They drafted Ewing, as expected, beginning a fifteen-year relationship.

Although injuries marred his first year in the league, he was named NBA Rookie of the Year, averaging 20 points, 9 rebounds, and 2 blocks per game. Soon after he was considered one of the premier centers in the league. Ewing enjoyed a successful career; eleven times named an NBA All-Star, once named to the All-NBA First Team, six times a member of the All-NBA Second Team, and named to the NBA All-Defensive Second Team three times. He was a member of the original Dream Team at the 1992 Olympic Games. He was also given the honor of being named one of the 50 Greatest Players in NBA History.

The Knicks played the defending NBA Champion Chicago Bulls and Michael Jordan in the 1992 Eastern Conference Semifinals. Ewing was unstoppable in Game 1, finishing with 34 points, 16 rebounds, and 6 blocks, and the Knicks beat Chicago 94–89. With the Knicks facing elimination, Game 6 is regarded as one of the greatest of Ewing's career. The Knicks trailed 3–2 in the series and Ewing was limited physically by a bad ankle sprain,[12] but he helped the Knicks beat the Bulls 100–86 by scoring 27 points. NBC announcer Marv Albert called it a "Willis Reed-type performance", but the Knicks were ultimately eliminated in Game 7 in a blowout, 110–81.

In a 1993 game[13] between the Knicks and the Charlotte Hornets, the 7'0" (2.14 m) Ewing suffered a moment of embarrassment when guardTyrone "Muggsy" Bogues, who stands a mere 5'3" (1.60 m), managed to block his shot.[14] The team looked like it was going to advance to the NBA Finals when they took a 2–0 lead over Michael Jordan's Chicago Bulls. Both teams battled well, each winning on its home court in the first 4 games. However, the Bulls stunned the Ewing-led Knicks, winning Game 5 in New York 97–94 after Ewing's teammate, Charles Smith, was repeatedly blocked down low by Bulls defenders on the game's final possession. The Bulls would go on to win Game 6 96–88 and then claim their third straight NBA title. This would be one more season in which Ewing had to deal with no championships, despite the fact that the Knicks had the best regular season record in the Eastern Conference at 60–22 and had the second best record in the NBA, behind the Phoenix Suns, who were 62–20.

With Jordan out of the league, 1993–94 was considered a wide open year in the NBA, and Ewing had declared that 1994 would be the Knicks' year. He was a key contributor to the Knicks' run to the 1994 NBA Finals, in which the Knicks—in the finals for the first time since 1973—lost in the final seconds of Games 6 and 7 to Hakeem Olajuwon's Houston Rockets. The Knicks, with Ewing leading them, had to survive a grueling trek through the playoffs simply to reach the Finals. They defeated Scottie Pippen's Bulls in seven games in the 1994 Eastern Conference Semifinals (all seven games were won by the home team), and defeated Reggie Miller's Indiana Pacers in the Conference Finals, which also took seven games to decide. In the Finals, the Knicks stole Game 2 in Houston, but couldn't hold court at home, dropping Game 3 at the Garden. The Knicks then won the next two games to return to Houston ahead 3–2. However, the Rockets won the next two games. Ewing made the most of his playoff run by setting a record for most blocked shots in a Finals series (broken by Tim Duncan in 2003). He also set an NBA Finals record for most blocked shots in a single game, with 8 (surpassed by Dwight Howard in 2009).

The following year, a potential game-tying finger roll by Ewing rimmed out in the dwindling seconds of Game 7 of the Eastern Conference Semifinals, resulting in a loss to the Indiana Pacers. In the 1995–96 season, Ewing and the Knicks were eliminated in the Eastern Conference Semifinals in 5 games by the record-setting Bulls, who won 72 games that year en route to their fourth championship.

In the 1997 playoffs, the Knicks faced the Miami Heat in the Eastern Conference Semifinals. Ewing was involved in a Game 5 brawl where both team's benches got involved. The Knicks, who were up 3–1 in the series going into Game 5, lost the next three games and were eliminated.

In the next season, Ewing's career almost came to an end due to an injury. On December 20, 1997, in a game against the Milwaukee Bucks at the Bradley Center, Ewing was fouled by Andrew Lang while attempting a dunk.[15] Ewing landed awkwardly as he came down, and his hand hit the floor first. The force of the foul and subsequent fall resulted in Ewing suffering a major injury that threatened his career. Ewing suffered a displaced fracture of the wrist on his shooting hand, with his lunate bone becoming dislocated from the force of the fall, and underwent surgery to stabilize the bone and prevent potential nerve damage. The next morning, it was discovered that not only was Ewing's wrist broken, but he had also torn ligaments in the joint. The type of injury Ewing suffered had not been seen in athletes, usually reserved for victims of vehicular accidents.[16] Ewing, who had only missed 20 games in the previous ten seasons, missed the remaining 56 games of the season.[17] However, he was able to rehabilitate the injury faster than expected and as the playoffs began, Ewing was talking about returning. The Heat and Knicks met up in the playoffs for the second straight year. This time, the 2 teams met up in the First Round of the playoffs. The series went to a decisive 5th game, but the Knicks avenged their loss to Miami the year before by beating the Heat in Miami 98–81. Ewing returned for Game 2 of the Eastern Conference Semifinals against the Indiana Pacers. His presence wasn't enough however, as the Knicks fell to the Pacers in 5 games.

The following season, Ewing and the Knicks qualified as the East's #8 seed in a lockout-shortened campaign. Although battling an Achilles tendon injury, Ewing led the Knicks to another victory over the Heat in the First Round, 3–2. They followed that up by sweeping Atlanta, and defeated the Pacers in the Conference Finals in 6 games, despite Ewing's injury finally forcing him out of action. However, the Knicks couldn't complete their Cinderella run, as they lost in the Finals to the Spurs 4–1.

In Ewing's final season as a Knick (1999–2000), the team finished as the #3 seed in the East behind the Pacers and Heat. The team advanced to the Conference Finals again, sweeping the Raptors and beating the Heat for the third straight year in 7 games, but could not defeat the Pacers and fell in 6 games. In his last year with the Knicks, Ewing had a game-winning slam dunk over Alonzo Mourning in Game 7 of the Eastern Conference Semifinals to lead the Knicks to the Eastern Conference Finals. During his final season as a Knick, Ewing played in his 1,000th NBA game, finishing his Knick career with a franchise-record 1,039 games played in a Knick uniform (He is the only player to play 1,000 games with the Knicks).

In 1,183 games over 16 seasons, Ewing averaged 21.0 points, 9.8 rebounds, and 2.4 blocks per game, and averaged better than a 50 percent shooting percentage. As of 2014, Ewing was ranked 18th on the NBA scoring list with 24,815 points.[18]

In 2001, Ewing testified in part of the Atlanta's Gold Club prostitution and fraud federal trial. The owner Thomas Sicignano, testified that he arranged for dancers to have sex with professional athletes. Ewing admitted he went to the club and received oral sex twice in the club. Ewing was never charged with any criminal wrongdoing.[19]

On February 28, 2003, Ewing's jersey number 33 was retired by the Knicks, for whom he played 1,039 games, in a large ceremony at Madison Square Garden.

In 1993 he led the NBA with 789 defensive rebounds. He was top ten in field goal percentage 8 times, top ten in rebounds per game as well as total rebounds 8 times, top ten in points, as well as points per game 8 times, and top ten in blocks per game for 13 years.[21]

In 1999, Ewing became the 10th player in NBA history to record 22,000 points and 10,000 rebounds.

Ewing played his final season (2001–02) with the Orlando Magic and became an assistant coach for the team in 2007.

From 2003 through 2006, Ewing was an assistant with the Houston Rockets, before resigning to spend more time with his family. On July 3, 2007, Ewing was one of four assistants hired to serve under first-year Orlando Magic head coach Stan Van Gundy[22] for the 2007–08 season.

Ewing was a key factor in the Magic's run to the 2009 NBA Finals, where they lost to the Los Angeles Lakers. He guaranteed a win in Game 7 of the second round against the defending champion Boston Celtics.[24] The Magic beat the Celtics 101 to 82 to win the series 4 games to 3. As a result, Ewing saw Magic captain Dwight Howard set a new NBA Finals record, for most blocked shots in a single finals game, with 9 in Game 4 of the finals, surpassing the previous record of 8, which Ewing himself set in Game 5 of the 1994 Finals.

In 2010, Ewing finally got the opportunity to coach his son Patrick Ewing Jr. in the 2010 summer league. Ewing Jr. played for the Magic.[25]

In 2013, Ewing became an assistant coach with the Charlotte Bobcats (Now Hornets).[26] On November 8, 2013, Ewing would end up coaching for the Bobcats as their interim head coach due to the team's regular head coach Steve Clifford having heart surgery during that time. He would end up losing in his first stint by the score of 101-91 against his former team, the New York Knicks.

Ewing's first sneaker endorsement was with Adidas in 1986.[30] In 1991, Next Sports signed a licensing deal to release footwear under Ewing's name in the United States under a new company, Ewing Athletics, which would operate until 1996.[31] In 2012, David Goldberg and his company GPF Footwear LLC successfully teamed up with Patrick to resurrect the old Ewing Athletics line, and bring it back into stores, capitalizing on the current retro trend in the footwear market.[32]

After friend and rival NBA center Alonzo Mourning was diagnosed with a kidney ailment in 2000, Ewing promised that he would donate one of his kidneys to Mourning if he ever needed one.[33] In 2003, Ewing was tested for kidney compatibility with Mourning, but Mourning's cousin was found to be the best match.[34] Ewing's son, Patrick Ewing, Jr., attended his father's alma mater, Georgetown University after two years at Indiana University. Ewing, Jr. wore the same jersey number that his father wore, #33. He was drafted by the Sacramento Kings in the second round with the 43rd pick of the 2008 NBA Draft, but was then traded to the New York Knicks, his father's old team. He did not make the Knicks' final roster, however. He has spent most of his career in the NBA D-League and in Europe.

^Ewing takes stand – barely, The Record (Bergen County) by Jason Tsai, October 27, 2006. "Former NBA star Patrick Ewing told jurors Thursday that he felt "violated" and frightened for his family's safety after his Englewood Cliffs home was ransacked seven years ago of more than $300,000 in property."